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A patina that often comes with age
Our love for the sun is ageless. Unfortunately, our skin isn't.
During a lifetime, your largest organ -- your skin -- has to protect you from countless environmental hazards. In doing so, it absorbs repeated damage. Ironically, the most detrimental of these hazards is one of the things that feel best on our skin: sunlight.
Our understanding of how sunlight affects the skin has increased dramatically. The importance of protecting oneself from the dangers of ultraviolet light is more widely accepted and understood than ever before. At the same time, the need to avoid ultraviolet light has increased as the thinning ozone layer -- our Earth's protective skin, so to speak -- leaves us more vulnerable to the sun's rays.
There are many useful over-the-counter and prescription medications for age spot treatment. Recently, several medical and surgical techniques that minimize age spots have also been developed.
Synonyms
- Liver spots
- Brown spots
- Sun spots
- Senile lentigo or solar lentigo
Detailed Description
Age spots are brown, freckle-like areas. Although they are called age spots, people in their 20s or 30s may have them if they have been exposed to a sufficient amount of sunlight -- especially those with fair complexions.
Age spots are a natural result of sunlight exposure. They show up when your body produces a pigment to help absorb the frequencies of light that can damage skin and the tissues below. While many of us consider age spots an unattractive sight, they signify that our body is trying to protect itself.
Virtually everyone with fair skin will get at least a few age spots in the course of their lives. Those with darker skin can get them as well, although they may show up later in life. Because age spots are due to sun exposure, they most frequently occur in sun-exposed areas such as the shoulders, the tops of the hands, the arms, and the face.
Age spots are perfectly harmless. In general, they do not change into any kind of skin cancer or premalignant skin growth. However, because many dangerous skin problems can resemble harmless age spots, it's important to have a doctor examine any suspicious areas of pigmentation.
How Common Are Age Spots?
Age spots occur more frequently in older people. People with a history of frequent sun exposure, such as fishermen, construction workers, and farmers, have a higher incidence of age spots than the general population. Fair-skinned people are more likely to see age spots in their skin.
Possible Underlying Causes
With long-term exposure to sunlight, the skin's uppermost layer, the epidermis, thins. Additionally, the skin's pigment-producing cells (melanocytes) increase production of the body's natural pigment, melanin. Melanin is a protective substance that absorbs the sun's harmful ultraviolet rays, stopping them from penetrating deeper into the skin.
Sun exposure has a cumulative effect. Aging and long-term sun exposure cause the skin to become more vulnerable to sun damage. As time goes by, the melanin produced in response to sun exposure collects in the flat, dark areas we call age spots.
Triggers of Age Spots
Age is the indirect factor that triggers age spots; exposure to sunlight over many years results in these pigmented areas. However, sunlight exposure in later years may make already present age spots worse.
Diagnosing the Underlying Cause
Age spots are one kind of process in which skin pigment increases. There are many kinds of skin conditions in which the pigment changes. Some of them, such as melanoma, require prompt medical attention. Therefore, it is important for you and your doctor to periodically inspect your skin for unusual changes. Be aware of the ABCDs of melanoma: asymmetry, border irregularity, color, and diameter. This is especially true when pigmented areas grow, bleed, itch, tingle, or ooze. Evaluation of pigmented areas takes into account your medical history, clinical appearance of the area, and in certain cases, the results of special tests. Other processes that cause increased pigment include:
- Seborrheic keratosis. A tan- to black-colored lesion with a raised surface and a greasy or wart-like appearance. These often occur on the torso. They require observation only, but can be removed if they bleed or cause irritation.
- Actinic or solar keratosis. A skin-colored or pink, sharply outlined lesion (3 mm to 10 mm) with a rough surface. They often occur in sun-exposed areas such as the face and top of the hands. An actinic keratosis is considered a precursor of squamous cell carcinoma, a dangerous type of skin cancer. Actinic keratoses can be treated with skin creams, surgical removal, laser treatment, or cryotherapy (freezing).
- Birthmarks or moles (nevus). A beige- to black-colored area of pigment (5 mm to 15 mm). These need only to be observed for change and usually do not require treatment of any kind.
- Melanoma. A brown, black, blue, red, or white lesion which may have an irregular outline and surface, usually measuring 5 mm or more. This is a dangerous skin cancer that can spread to other parts of the body. Melanomas must be surgically removed and treated aggressively.
- Freckles (ephelides). Tan-colored spots 2 mm to 5 mm in size on sun-exposed surfaces. Freckles do not require treatment.
- Cafe-au-lait spots. Brownish spots of various sizes with irregular borders. These are commonly found alone. Numerous spots are found in rare disorders including neurofibromatosis and Albright's syndrome.
Diagnostic Procedures
A Wood's light (a special ultraviolet lamp) may be used to examine the skin. If your physician believes your pigmented spot may be dangerous, a skin biopsy may be performed. A sample of the tissue can be sent to a pathologist for microscopic examination. The cells of the pigmented area can be identified as malignant (cancerous) or benign (harmless).
Goals of Treatment
Treatment for age spots is usually unnecessary unless you are bothered by your skin's appearance. If you wish to have age spots removed, the following treatment methods are available:
- Laser treatment. Lasers have been designed to target melanin, the pigment found in brown age spots. These lasers break up the pigment in the spots. The lesions usually disappear permanently after one or two treatments, but the effectiveness of laser treatment varies among individuals.
- Topical creams. There are several over-the-counter skin-bleaching creams that can help fade age spots if they are not too dark. Such bleaching creams contain hydroquinone, and should be used according to the manufacturer's directions. Retin-A (tretinoin) is a prescription cream that can be used to diminish age spots. It causes peeling of the superficial layers of skin, which are then replaced by newly formed skin tissue. It works slowly, showing results over the course of several months. There are also creams available to help treat actinic or solar keratoses. These creams contain fluorouracil.
- Cryotherapy. Stubborn age spots may be removed with cryotherapy or freezing. Using liquid nitrogen, your doctor can freeze the spots, which then usually peel off in four to five days.
- Chemical peel. If you have many spots concentrated in one area, a chemical peel might suit you. A mild acid such as trichloroacetic acid (TCA) is used to burn off the top layer of skin where the spots are located.
Treatment Options
Products most commonly used
Though there are just a few alternative remedies specifically used to reduce age spots, there are several alternative therapies to help improve the skin as a whole.
Herbs
- Aloe vera gel: said to bleach or fade age spots. Many herbalists suggest rubbing age spots with a freshly cut piece of aloe rather than using commercial preparations, which can contain little active aloe vera.
- Comfrey root: A paste made of the dried root is left on spots for 20 minutes, then rinsed off with lemon juice.
Supplements
Taking the following vitamins and minerals may help protect skin from sun damage and hyperpigmentation:
NOTE: Vitamin A supplements should be used with caution, as excessive use can damage the liver. Vitamin A should also be discontinued during pregnancy and at least three months before attempting to conceive a child.
Preventing Age Spots
Avoiding sun exposure is the only prevention against age spots. This is especially important for fair-skinned people. Exercise good judgment about the amount of sun you get -- it's the best way to avoid age spots down the road. You can also minimize the appearance of age spots by doing the following:
- Wear a hat and long sleeves on sunny days to reduce the area of skin exposed to sunlight.
- Ultraviolet rays still abound on cloudy or overcast days. If you must be outside regularly, wear sunblock with a sun protection factor (SPF) of at least 15, whether it's sunny or cloudy. Make sure it blocks both ultraviolet A and B rays.
When to Call the Doctor
Consult a doctor if an area of pigmented skin begins to bleed, tingle, itch, grow in size, or change in appearance.
Websites & Organizations
American Academy of Dermatology
930 N. Meacham Road
Schaumburg, IL 60173
Phone: 847-330-0230 or 888-462-DERM (888-462-3376)
American Skin Association
150 East 58th Street, 32nd Floor
New York, NY 10155-0002
Phone: 212-753-8260.
Dermatology Foundation
1560 Sherman Avenue
Evanston, IL 60201-4808
Phone: 312-328-2256
National Health Information Center
P.O. Box 1133
Washington, DC 20013-1133
Phone: 301-565-4167 or 800-336-4797
Fax: 301-984-4256
Email: mailto:nhicinfo@health.org
The Society for Investigative Dermatology
Suite 340, 820 West Superior Avenue
Cleveland, OH 44113-1800
Phone: 216-579-9300
Fax: 216-579-9333
Email: SID@SIDNET.org
ThriveOnline
Women's Dermatologic Society
930 North Meacham Road
Schaumberg, IL 60173
Phone: 847-330-9830
Fax: 847-330-1135
Email: kward@aad.org
Sources & Further Reading
Books
Balch, James F. and Phyllis A. Balch. Prescription for Nutritional Healing. Garden City Park, NY: Avery Publishing, 1997.
Bennett, J. Claude, and Fred Plum, eds. Cecil Textbook of Medicine. Philadelphia: W. B. Saunders, 1996.
Fauci, Anthony J., et al, eds. Harrison's Principles of Internal Medicine. New York: McGraw-Hill, 1998.
Hardman, Joel G. and Lee E. Limbird, eds. Goodman and Gilman's The Pharmacological Basis of Therapeutics. New York: McGraw-Hill, 1996.
Hurst, J. Willis, ed. Medicine for the Practicing Physician. Stamford, CT: Appleton & Lange, 1996.
Murray, Michael T. Encyclopedia of Natural Medicine. Prima, 1998.
Noble, John, ed. Primary Care Medicine. St. Louis: Mosby, 1996.
Physicians' Desk Reference. Montvale, NJ: Medical Economics Co., 1998.
Rakel, Robert E., ed. Conn's Current Therapy. Philadelphia: W.B. Saunders, 1998.
Taylor, Robert B. Family Medicine: Principles and Practice. New York: Springer-Verlag, 1998.
Tierney, L.M., S.J. McPhee, and M.A. Papadakis, eds. Current Medical Diagnosis and Treatment. Stamford, CT: Appleton & Lange, 1998.
Articles
Bolognia, J.L. "Aging Skin." American Journal of Medicine 98:1A (1995):99S-103S.
Ellis, F.A. "Nevi vs. Moles: Senile Lentigo Maligna--Diagnosis and Prognosis." Southern Medical Journal 59:5 (1966):509-14.
Garbe, C. et al. "Associated Factors in the Prevalence of More than 50 Common Melanocytic Nevi, Atypical Melanocytic Nevi, and Actinic Lentigines: Multicenter Case-Control Study of the Central Malignant Melanoma Registry of the German Dermatological Society." Journal of Investigative Dermatology 102:5 (May):700-5.
Goldfarb, M.T., C.N. Ellis, and J.J. Voorhees. "Topical Tretinoin: Its Use in Daily Practice to Reverse Photoageing." British Journal of Dermatology 122 Supp. 35 (1990):87-91.
H"olzle, E. "Pigmented Lesions as a Sign of Photodamage." British Journal of Dermatology 127 Supp. 41 (1992):48-50.
Kligman, A.M. "Guidelines for the Use of Topical Tretinoin (Retin-A) for Photoaged Skin." Journal of the American Academy of Dermatology 21 (1989):650-4.
Kligman, A.M. and C. Koblenzer. "Demographics and Psychological Implications for the Aging Population." Dermatology Clin 15 (1997):549-53.
Lim, J.T. and S.N. Tham. "Glycolic Acid Peels in the Treatment of Melasma Among Asian Women." Dermatological Surgery 23 (1997):177-9.
Rafal, E.S., C.E. Griffiths, C.M. Ditre, L.J. Finkel, T.A. Hamilton, C.N. Ellis, and J.J. Voorhees. "Topical Tretinoin (Retinoic acid) Treatment for Liver Spots Associated with Photodamage." New England Journal of Medicine 326 (1992):368-74.
Van Scott, E.J., and R.J. Yu. "Alpha Hydroxy Acids: Procedures for Use in Clinical Practice." Cutis. 43 (1989):222-8.